Clinical Profile of Patients with Common Bile Duct Stones Attending Tertiary Care Hospital

Journal of Critical Reviews

ISSN- 2394-5125 Vol 7, Issue 6, 2020

Review Article CLINICAL PROFILE OF PATIENTS WITH COMMON BILE DUCT STONES ATTENDING TERTIARY CARE HOSPITAL

1Dr. A.Y. Kshirsagar, 2Dr. C Z Pardesi, 3Dr. Ashvini Padmakar Mahamuni

Professor, Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India Assistant professor, Professor, Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India. Junior resident Professor, Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India.

Corresponding author- Dr. C Z Pardesi, Assistant professor, Professor, Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India

Received: 28.02.2020 Revised: 25.03.2020 Accepted: 22.04.2020

Abstract: Introduction: Common bile duct stones are seen in around 6 to 12% of patients having stones in the gallbladder. As the age increases the incidence of bile duct stone also increases. These stones might be asymptomatic and are regularly found by chance. The aim of present study was to study the Clinical profile of patients with common bile duct stones attending tertiary care hospital. Material and methods: This cross-sectional examination was done in 84 patients of common bile duct stones in the department of Surgery of a tertiary health care hospital for time of one-year. Results: Most of the patients were Female that is 58.33% %, trailed by Males that is 41.66%. Most of patients in our study were from age group 41 – 60 years. Pain, jaundice and fever were the most common symptoms. Tenderness-Rt. Hypochondriac and icterus were the most common signs. The risk factors contributing to the disease were non- vegetarian diet low in fiber, sedentary life style, over weight and obese people. Patients with diabetes mellitus, hypertension and h/o liver diseases were also at more risk. Conclusion: It can be concluded from our study that bile duct stones are common in patients in age group 41- 60 years. The most symptoms were pain, jaundice and fever. The most common signs were Tenderness-Rt. Hypochondriac and icterus. The most common risk factors were non- vegetarian diet low in fiber, sedentary life style, over weight and obese people.

Key words: bile stone, common bile duct, liver disease

INTRODUCTION: 3. Acute cholecystitis Gallstone disease stays one of the significant reasons for 4. Primary Sclerosing Cholangitis abdominal morbidity and death around the globe.1 Diseases of 5. Gallstone Ileus the gallbladder are normal and expensive. Gallstone ailment is 6. Biliary cirrhosis a chronic repetitive hepatobiliary disease, the reason for which is the hindered metabolism of cholesterol, bilirubin and Present study aimed to study the Clinical profile of patients bile acids, which is portrayed by the development of gallstones with common bile duct stones attending tertiary care hospital. in the hepatic bile duct, common bile duct, or gallbladder.2 MATERIAL AND METHODS Common bile duct stones be present in 6 to 12% of patients This cross-sectional examination was done in 84 patients of with stones in the gallbladder. The occurrence increments common bile duct stones in the department of Surgery of a 3 with age. The occurrence of gallbladder stones fluctuates tertiary health care hospital for time of one-year. broadly in various regions in India. The North Indians have 2-4 All the patients included in our study were made to sign a well times increased prevalence on comparison with South explained written consent form. All details of the patients like 4 Indians. Also, there is a high proportion of cholesterol age, sex, Clinical features and associated factors like Age, gallstones among the north Indians and that is seen both in Obesity (calculated by BMI), H/o Diabetes, H/o hypertension gallbladder and common bile duct stone analysis, including the H/o Liver disease, Non- Vegetarian diet, Diet low in fiber etc. common bile duct stones not joined by a self evident stone in were recorded. The data was tabulated and percentages were the gallbladder. Interestingly, South Indians have a calculated. predominance of pigment gallstones both in the gall bladder 5 and CBD. RESULTS:

Out of 84 patients in our study 49 (58.33%) were females and 6 Problems with common bile duct stone consists of: 35 (41.66%) were males. 1. Obstructive jaundice 2. Acute Pancreatitis Table 1: Distribution of the patients as per the age Age Number of patients Percentage ≤20 - - 21-40 21 25% 41-60 47 55.95% ≥61 16 19.04

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Table 2: Risk factors Clinical profile Number of patients Percentage Diet Vegetarian 36 42.85% Non-vegetarian (Mixed) 48 57.14% Lifestyle/Physical activity Sedentary 49 58.33% Moderate 26 30.95% Heavy 9 10.71% Built Underweight 5 5.95% Normal weight 16 19.04% Over weight 40 47.61% Obese 23 27.38 Comorbid medical illness Diabetes mellitus 32 38.09% Hypertension 27 32.14% H/o liver disease 22 26.19%

Table 3: Symptoms Symptoms Number of patients Percentage Pain 67 79.76% Fever 44 52.38% Jaundice 61 72.61% Dyspepsia, Nausea, Vomiting 31 36.90% Itching 12 14.28% Clay coloured stool 29 34.52%

Table 4: Signs Signs Number of patients Percentage Icterus 76 90.47% Temperature 46 54.76% Tenderness-Rt. Hypochondriac 78 92.85 Hepatomegaly 4 4.76%

DISCUSSION: Comorbid medical illness that contributed to risk factors are Bile duct stones have a low death rate, it’s financial and diabetes mellitus, hypertension and h/o liver disease. wellbeing effect is noteworthy because of its high morbidity.7 The significant components which are engaged with the CONCLUSION arrangement of gall stones are cholesterol, bile pigments, It can be concluded from our study that bile duct stones are calcium, hepatic bile composition, biliary glycoprotein, common in patients in age group 41- 60 years. The most infection, age, sex, genetics, oestrogen, dietary factors, symptoms were pain, jaundice and fever. The most common geographical prevalence, and cirrhosis of the liver.8 Majority of signs were Tenderness-Rt. Hypochondriac and icterus. The the bile duct stone patients doesn’t show any symptoms and most common risk factors were non- vegetarian diet low in therefore current investigation depicts a broad viewpoint into fiber, sedentary life style, over weight and obese people. the age and sex distribution, the risk factors, signs and symptoms of the people suffering from bile duct stones. REFERENCES: 1. Tazuma S. Gallstone disease: epidemiology, pathogenesis, In present examination we have seen that out of 84 patients 49 and classification of biliary stones (common bile duct and (58.33%) were females and 35 (41.66%) were males. The intrahepatic). Best Pract Res Clin Gastroenterol. 2006; outcome of our study is in concordance with the studies done 20:1075-83. 6 9 by Dharmesh P et al and Chhoda A et al who stated that that 2. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and a notably higher extent of females on comparison to males cholecystitis. J Long Term Eff Med Implants. 2005; were in-between likelihood group for common bile duct stone 15:329-38. and proposes that better gender stratification can help 3. Sdottir MO, Pham TH, Hunter JG. Gall bladder and The improve the positive and negative prescient estimations of Extra Hepatic Biliary System. In: Brunicard FC, Anderson (American Society for Gastrointestinal Endoscopy) ASGE risk DK, Billiar TR, Dunn DL, Hunter JG, Mathew JB, Pollock stratification criteria and improve patient outcomes and RE, eds. Schwartz’s Principles of Surgery, 9TH ed. New reduce associated healthcare cost. York: The McGraw-Hills Companies, Inc, 2010, 1142- 8. The majority of patients are from age group 41 -60 (55.95%). 4. Tandon RK. Prevalence and type of biliary stones in india. This is comparable to the investigation done by Ravi MJ et al10 World J Gastroenterology. 2000; 6(3):4-5. who also reported maximum incidence in the age group of 41 5. Mund RR, Priyadarshini P, Meher SK. Study on to 60, accounting for 46.7%. The plausible explanation being aetiopathogenesis and management of common bile duct sited is that in older patients common bile duct stone are for stones in southern part of Odisha, India. International the most part because of relocation of primary gall bladder Journal of Medical and Health Research. 2017:3(2):74-7. stone at later age.6 These findings are comparable to the 6. Dharmesh P. Vasavada, Ridham Khanderia. A study of investigation done by Joana Tozatti J et al11 who clinical outcome in 30 patients of common bile duct recommended that the best indicators of common bile duct stone. International Journal of Contemporary Medical stones in patients before cholecystectomy were features of Research 2019;6(4):D1-D5. cholangitis (right hypochondriac pain, jaundice and fever) and 7. Tandon RK, Saraya A, Paul S, Kapur BM. Dietary habits of ultrasound evidence of stones in the common bile duct. gall stone patients in northern India. J Clin Gastroenterol 1996; 22: 23-7. In a progression of 2455 patients of choledocholithiasis by 8. Selvaraju R, Ganapathi Raman R, Thiruppathi G, Wani NA et al12 the symptoms were pain in abdomen 94.90%, Valliappan R. An epidemiological study of gall stones in fever with rigors 13.44% and jaundice 43%. the Cuddalore district. Int J Pharm Tech Res 2010; 2: 1061-67. The most common risk factors were non- vegetarian diet low 9. Chhoda A, Jain D, Singhal S. Sex-related differences in in fiber, sedentary life style, over weight and obese people. predicting choledocholithiasis using current American

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Society of Gastrointestinal Endoscopy risk criteria. Ann Gastroenterol. 2017; 30: 682–7. 10. Ravi MJ. Clinical profile of patients with common bile duct stones attending tertiary care hospital. International Journal of Surgery Science 2019; 3(2): 73-76. 11. Tozatti J, Mello AL, Frazon O. Predictor factors for choledocholithiasis. Arq Bras Cir Dig. 2015;28:109-12. 12. Wani NA, Khan ZA, Ahmad HW. Experience with calculus biliary tract surgery. Indian J Surg. 1995;181-3.

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